CHEST
Volume 119, Issue 3, March 2001, Pages 685-690
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Clinical Investigations
Relationship Between Bronchial Hyperresponsiveness and Development of Asthma in Wheezy Infants

https://doi.org/10.1378/chest.119.3.685Get rights and content

Study objectives:

To evaluate the relationship betweenbronchial hyperresponsiveness (BHR) in infants with wheezing and thesubsequent development of asthma.

Intervention:

Bronchial reactivity to inhaled methacholine (BRm) during the infantileperiod was studied using the transcutaneous partial pressure of oxygen (tcPo2) method. Children werefollowed long-term for the development of asthma.

Patients:

Fourteen children with bronchiolitis (mean age,0.7 years) and 48 with wheezy bronchitis (mean age, 2.3 years) wereenrolled. For comparison, 40 children with asthma (mean age, 4.6 years)and 27 healthy control subjects with out chronic respiratory disease(mean age, 2.7 years) were studied.

Measurements:

Consecutive doses of methacholine were doubled until a 10% decrease intcPo2 from baseline was reached. The cumulativedose of methacholine (Dmin) at the inflection point of tcPo2 (Dmin-Po2) wasrecorded.

Results:

During > 10 years of follow-up, seven patients with bronchiolitis developed asthma and allpatients in the higher BRm set developed asthma, compared with none in the lower BRm set. In the wheezy bronchitis group, Dmin-Po2 values in the 32 patients whodeveloped asthma were lower than those in patients who had notdeveloped asthma (p < 0.001).

Conclusions:

Weconcluded that there is a tendency for infants with a clinicaldiagnosis of bronchiolitis or wheezy bronchitis and who show BHR in theinfantile period to develop asthma. The presence of increased BHR afterinfantile respiratory diseases associated with wheezing may be aprelude to the development of childhood asthma.

Section snippets

Study Subjects

Fourteen infants with bronchiolitis (11 boys and 3 girls; agerange, 10 months to 2 years; mean age, 0.7 years) and 48 infants with wheezy bronchitis (25 boys and 23 girls; age range, 10 months to 6years; mean age, 2.3 years) participated in this study (Table 1). All subjects with bronchiolitis and 44 of the 48 subjects with wheezybronchitis were atopic. In this report, the clinical diagnosis of atopywas based on a positive family history of allergy or a positivereaction to common environmental

Results

During the methacholine inhalation challenge, the maximum decreasein tcPo2 was between 10 and 20 mm Hgin all children. All patients underwent the methacholine inhalationchallenge safely. There were no differences in baselinetcPo2 values among the bronchiolitis, wheezy bronchitis, asthma, and control groups (p > 0.1).

The mean value of Dmin-Po2 in infantswith bronchiolitis (8.1 ± 0.9 U) was significantly lower than thatin control subjects (21.0 ± 3.9 U) (p < 0.01) and wassignificantly higher than

Discussion

In this study, we showed that the meanDmin-Po2 in infants with bronchiolitis or wheezy bronchitis was lower than that in controlsubjects and was higher than that in asthmatic patients; 50% of children with bronchiolitis and 41% of children with wheezy bronchitiswho showed greater BHR subsequently developed asthma.

We previously evaluated BHR in infants with asthma by monitoringtcPo2. During an acute attack of asthma, tcPo2 correlates linearly tothe severity of the attack. Methacholine-induced

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